Combat Lifesaver vs. EMT/Medic

[Veneficus]

I would have to show them short cuts. And the best unit is Specialty Care if you are an EMT!!!!

You are comparing the combat specific aid training for people in combat to that of a civillian EMT?

That just somehow doesn't seem like a good idea to me?

 

[Dre]

I'm actually a NJ EMT. I also was apart ofvthe CLS course before it was mandatory. That's how come I was good at drawing blood. In addition, I was about to take the 2 year course as a paramedic. I don't know the entire SF Medic course, but the key training is ACLS in addition to others. Had I take T-EMS, I would have been ready as a combat medic in the Army. I think I can basically make at least a general comment on the training. Civilian EMS was adopted after the military. ie MAST was a combat shock garment that was passed down to civilians. In addition to the tourniquets. So. If I shoot from the waist, I have enough ammo!

My dad was a combat medic.

 

[Dre]

Also, my point was that the degrees in comparison to civilians training is how it is looked at. I'll look at the PDF of the cuurent doctrine online and compare it to the 2001 course I took.

 

[rwik123]

There's a major distinction between the CLS and even a basic emt. The CLS course does not go into much of the physiology on what it happening. It's just a sign by sign course which addresses the leading causes of death in the battle field.. Which are obviously airway and hemorrhaging. Like it was said earlier, this is the extent of the course.. Therefor it is not applicable in the civilian world because the scope is so narrow and limited to traumatic injuries on extremely healthy young individuals. No ob, environmental, or extrication skills that would be needed by a basic.

 

[Dre]

A CFR or Certified First Responder are basically police and fire. They are trained in putting oxygen on and C-Spine stabilization. One an Ambulance, they can only do as directed with instructions. Basically, it's the person who said "can I help". Again, the civilian EMS is the same as the military with state regulations. My point was to say to civilians that read this, these are the levels. Just that CLS can do IV's. Paramedic and EMT-I's can. NJ has a small CFR program and no EMT-I.

 

[Veneficus]

The CLS course does not go into much of the physiology on what it happening.

Neither does EMT class.

I am eagerly watching the latest Mr.Brown thread and discovering that as textbook as it is, apparently not much is taught in paramedic class in the way of pathophysiology either.

It's just a sign by sign course which addresses the leading causes of death in the battle field.. Which are obviously airway and hemorrhaging. Like it was said earlier, this is the extent of the course.. Therefor it is not applicable in the civilian world because the scope is so narrow and limited to traumatic injuries on extremely healthy young individuals. No ob, environmental, or extrication skills that would be needed by a basic.

Are you saying it cannot be compared, or that one is superior to the other?

I really can't see how a civillian EMT is going to show shortcuts and teach the instructors a little more, especially considering the knowledge and experience of some of the self identified instructors on this board.

I cannot imagine Basic EMTs Showing anyone the best way to decompress chests or apply a TK with as often as it is done in the civilian world.

I commend the comparison of the MAST as something handed down by the military. Especially since its purported mechanism doesn't work, and what really makes it useful is the pneumatic compression of the abd aorta in a very small subset of pathology.

I also respectfully request a more articulate argument than "my dad was a medic" doctor, grand pubah, whatever. I have heard it phrased many ways before and it always sounds pityful.

My dad was a combat infantryman and a steelworker. You know what special information and skills that confers on me?

Nothing.

Just like my wife, daughter, mother, sister etc. have no special medical knowledge granted to them.

 

[Dre]

Well, I have to wait. The just changed the entire EMS protocols for NJ. I'll check NY's. Thats the only Paramedic program NJ follows, that I know. But it's a college course here.

 

[rwik123]

Neither does EMT class.

I am eagerly watching the latest Mr.Brown thread and discovering that as textbook as it is, apparently not much is taught in paramedic class in the way of pathophysiology either.



Are you saying it cannot be compared, or that one is superior to the other?

I really can't see how a civillian EMT is going to show shortcuts and teach the instructors a little more, especially considering the knowledge and experience of some of the self identified instructors on this board.

I cannot imagine Basic EMTs Showing anyone the best way to decompress chests or apply a TK with as often as it is done in the civilian world.

I commend the comparison of the MAST as something handed down by the military. Especially since its purported mechanism doesn't work, and what really makes it useful is the pneumatic compression of the abd aorta in a very small subset of pathology.

I also respectfully request a more articulate argument than "my dad was a medic" doctor, grand pubah, whatever. I have heard it phrased many ways before and it always sounds pityful.

My dad was a combat infantryman and a steelworker. You know what special information and skills that confers on me?

Nothing.

Just like my wife, daughter, mother, sister etc. have no special medical knowledge granted to them.

there two different animals. Obviously an EMT isnt going to be able to do half the stuff a guy that has taken a CLS class can do. And the other way around, a guy who has taken a CLS course does not have some of the knowledge that we have. So they are each better at their own discipline, but not truly comparable or able to switch places.

"I cannot imagine Basic EMTs Showing anyone the best way to decompress chests or apply a TK with as often as it is done in the civilian world. "

ok?.. I cannot imagine a CLS certified soldier showing how to backboard someone or birth a child. Your comparisons are flawed because they are not comparable certifications.

 

[Veneficus]

ok?.. I cannot imagine a CLS certified soldier showing how to backboard someone or birth a child. Your comparisons are flawed because they are not comparable certifications.

Fair enough, but I was trying to find an example that was something that could have a definitive outcome with the skills available.

We know that backboarding and childbirthing may not mke any difference at all.

Bt my point was that an EMT cannot start telling people trained specifically to their very narrow environment the best way to do things with the skills and knowledge that they have at their disposal.

 

[rwik123]

Fair enough, but I was trying to find an example that was something that could have a definitive outcome with the skills available.

We know that backboarding and childbirthing may not mke any difference at all.

Bt my point was that an EMT cannot start telling people trained specifically to their very narrow environment the best way to do things with the skills and knowledge that they have at their disposal.

yeah i totally agree with the ending point.. if I got shot i would want to be cared by someone with someone who has less knowledge in general, but a higher amount of speciality instead of being cared by say an emt who has a broader range of skills but is not familiar with that situation and less trained on that specific situation with less interventions at their disposal

 

[Combat_Medic]

Just that CLS can do IV's.

Don't know if this was mentioned before but IV's were removed from CLS traning. All IV supplys have also been removed from all CLS bags.

 

[MackTheKnife]

Cat

I suppose that would drive you nuts. Almost like our sixteen week Technicians who tell Intensive Care officers not do to something they've probably been doing for twenty years!

However, I suppose we can't find fault with thier way of doing things; thier modality suits the situations they encounter; I haven't encountered anybody yet who has had several limbs or thier guts blown out as a result of an IAD out there on the civillian street.

Speaking of the CAT, we have that now. Tourniquets here were not the norm or a formal procedure however they were used for severe, uncontrollabe bleeding and made out of a pillow case. Never seen one used yet.

CAT works well but the MET tourniquet is better IMHO. The windlass on the CAT is plastic and some tended to break when being applied. The windlass on the MET is aluminum.

 

[MackTheKnife]

No sh*t?

Don't know if this was mentioned before but IV's were removed from CLS traning. All IV supplys have also been removed from all CLS bags.

They removed IV's? Did they give a reason? I wonder if CLS is going more the route of TCCC?

 

[MackTheKnife]

Correction

There's a major distinction between the CLS and even a basic emt. The CLS course does not go into much of the physiology on what it happening. It's just a sign by sign course which addresses the leading causes of death in the battle field.. Which are obviously airway and hemorrhaging. Like it was said earlier, this is the extent of the course.. Therefor it is not applicable in the civilian world because the scope is so narrow and limited to traumatic injuries on extremely healthy young individuals. No ob, environmental, or extrication skills that would be needed by a basic.

Just as an FYI, it's uncontrolled extremity hemorrhaging (approx 67% of preventable battlefield deaths), undiagnosed/untreated tension pneumothorax (approx 30%), and lastly airway (approx 6%). The remaing 1% is non-combat related.

 

[Akulahawk]

Just as an FYI, it's uncontrolled extremity hemorrhaging (approx 67% of preventable battlefield deaths), undiagnosed/untreated tension pneumothorax (approx 30%), and lastly airway (approx 6%). The remaing 1% is non-combat related.

Given the armor that is worn, I would certainly expect to see extremity hemorrhage, tension pneumo, and airway issues being the major causes of battlefield death where the person wasn't immediately killed.

Body armor doesn't cover the extremities and can easily make tension pneumo difficult to detect until the signs become overt by hiding an external wound...

IV's seem to have been removed from the CLS because too much time was spent dealing with IV stuff and treating preventable causes of death needed to be addressed more. Let the unit medic/corpsman do the IV. Those folks know enough to not flood the patient with fluid...

 

[EMT11KDL]

As I was just an instructor for the CLS class this past week for my Unit, I did have them to IV's. Because you never know when you (as the medic) might need help getting a line established on a patient or help spiking a bag. Or you might be one injured.

 

[EMT11KDL]

They removed IV's? Did they give a reason? I wonder if CLS is going more the route of TCCC?

The reason why IV were removed is actually pretty simple. The CLS guys in the field were spending to much time worrying and attempting to gain access via IV instead of treating there patient.

 

[Afflixion]

Sorry to jump into this a little on the late side but, first off the CAT is starting to be replaced by the SOFT-T as it is more reliable and will actually stop hemorrhaging from femoral bleeds. The majority of light infantrymen have muscular thighs and the CAT will not fit around or will snap prior to stopping bleeding.

Secondly, the true reasoning why IV resuscitation was removed from the CLS is a few reasons, the most importantly as I have personally seen is CLS like to think of IVs as their "core skill" and will try to start an infusion prior to any other care even on the CUF (care under fire.) Now CLS is focusing on proper patient assessment more than anything else, which is what CLS personnel truly needs. One more reasoning is people going into circulatory overload in their barracks room after drinking heavily that night trying to sober up before morning PT, which still happens quite frequently. IV's are not some arbitrary skill that anyone who knows how to stick can do, you must learn the proper hemodynamics of the vascular system along with the different reasonings and uses for different fluids. Which brings me to another point if you push to much fluid and raise systolic BP above 93mmHg you will blow any clots formed with trauma patients which is something that is not taught to CLS and is still rarely taught to line medics. If you are still teaching IVs to CLS there is a proper reasoning why it was removed and because you feel you know better than an entire board of physicians and NP/PAs you are sorely mistaken. As we say in the military's "murphy's laws of combat" If it looks stupid and works than it isn't stupid.

Finally, one cannot compare CLS or even military medics to any form of CLS, their scope of practice and methods of doing things are completely different. If CLS were taught enough civilian medicine then don't you think the Army would certify them as EMRs ,with the "new" army being so focused on civilian education now? CLS is exactly what the name states someone who may be able to save a life under battlefield conditions, nothing more and nothing less.

 

[NSW1979]

first off the CAT is starting to be replaced by the SOFT-T as it is more reliable and will actually stop hemorrhaging from femoral bleeds. The majority of light infantrymen have muscular thighs and the CAT will not fit around or will snap prior to stopping bleeding.

. One more reasoning is people going into circulatory overload in their barracks room after drinking heavily that night trying to sober up before morning PT, which still happens quite frequently.

Afflixation is dead on about the soft -t vs CAT. I was deployed most of 2010. During that time, I had to use a C.A.T. after an IED blast. I use the C.A.T. in the soldiers IFAC (little personal aid bag that is carried on all soldiers) on his L leg which was riddle with shrapnel and bleeding profusely. The damn windlass snapped in half. Luckily I had a SOFT-T on my IOTV. Saved the day and his life. Turns out his femoral artery was severed right above the knee. Never again have I used a C.A.T.

IV's was taken out becuase like some stated, the soldiers who are non medics, would go straight for the IV before controlling the hemorrhaging. The Barracks was another issue as well. I do stay in the barrack and I am authorized to give IVS to drunks, but only when the soldiers platoon sergeant gives the go ahead. With evac times in most cases are 15 mins or less in iraq then main focus for care is stop the bleeding and start the breathing. HABC's at its finest. Plus Hextend is a dangerous thing when it comes to those who don't know what it does or how to use it right. A fool with an IV is sometimes more dangerous than the enemy with a weapon. (i see PT's come in from the field with circulatory overload because the non medic was so focused on ivs.

 

[Whiskey Medic]

Wow

I do stay in the barrack and I am authorized to give IVS to drunks, but only when the soldiers platoon sergeant gives the go ahead.

Since when are platoon sergeants medical officers. Just sayin'